Strategies for Standing

Sustaining any one position is often uncomfortable for people with low back difficulties. Many individuals with a medical diagnosis of lumbar spine stenosis or intervertebral disc disorder develop low back and/or lower extremity pain upon standing for more than 5 or 1 0 minutes. Individuals with lumbar spinal stenosis have spatial compromise within the vertebral canal or nerve foramen that may irritate sensitive nerve structures and cause pain radiation in the lower extremity. Likewise, a weak lumbar intervertebral disc may compress and deform more readily upon prolonged standing causing low back or lower extremity nerve pain.

With practice, therapeutic strategies can be implemented that can reduce or eliminate symptoms from the low back secondary to standing. Not all strategies apply to each individual having low back difficulty in standing and therefore each condition needs to be evaluated so as to determine the most effective strategy. Given this understanding one or more of the following strategies may be of help to you in lessening discomfort from the low back while standing.

1.

If you are standing at a table, countertop or standing work surface you may find placing one foot on a footstool to provide symptom reduction. The use of a footstool can change the lumbar spinal curve in a manner to lessen load on pain sensitive back tissues (Fig. 1).

2.

The amount of hip and knee bend in standing also can influence lumbar spine alignment. Hip and knee extension (straightening) will exaggerate the low back curve while hip and knee flexion (bending) decreases the curve in the low back. The amount of muscle activity in the low back and lower extremities is also influenced by hip and knee position. By having the hips and knees slightly bent some of the work expenditure necessary to stand is transferred to the leg muscles, which may enable the low back muscles to work less thus reducing low back fatigue.

3.

With practice one can learn how to change lumbar spine position by tilting the pelvis. Pelvic tilt may either increase or decrease the lumbar curve thereby changing the body’s weight line to less pain sensitive structures. Figure 2 demonstrates how tilting the pelvis changes lumbar curvature. Note that tilting the pelvis backwards reduces lumbar curve while tilting the pelvis forward increases the curve.

4.

Standing tall by raising the collar bones may help to sufficiently activate the abdominal muscles for postural stabilization during standing. Learning how to properly perform the abdominal drawing in maneuver may also assist in providing additional postural support for standing (Fig. 3).

5.

The gluteal muscles can be recruited to provide postural support for standing. An isometric pressing or squeezing of the gluteals improves lower extremity dynamic support for the spine when standing. Gluteal contraction can help to simultaneously activate the deep extensor muscles in the lumbar spine which also are used for spinal stabilization.

6.

Postural sway and weight shifting during standing is normal and encouraged. Shifting weight from one leg to the other is natural and helps to ease pressure on one side of the spine.

Learning which of the various strategies suggested is most effective to lessen pain when standing requires awareness and practice. Having positional options while standing helps to decrease low back stress and fatigue. Success in reducing low back pain in standing may be dependent on learning how to implement the strategies correctly and efficiently which is enhanced through one-on-one physical therapy education.

For more information specific to your condition, contact the Atlanta Back Clinic, or call us at 770-491-6004 to set up an appointment with a physical therapist.